【醫(yī)學(xué)課件】timi-iiia研究課件

IVHeparin,(ASA),Beta-blockers,Nitrates,Ca++blockersRandomizeAngio18-36hrst-PA0.8mg/kgover90mins391PatientswithUnstableAngina/NQWMIPlaceboPrimaryEndpoint:Death,MI,PositiveETT6weeksFollow-up6weeksCirculation1993;87:38-52BaselineAngioAngioExclusion:noCADorLMainTIMIIIIAProtocolDesign天馬行空官方博客：/tmxk_docin；QQ:1318241189；QQ群：1755696321

Apparentthrombus35%Possiblethrombus30%Nothrombus35%ImprovementinCulpritLesion:25%t-PAvs.19%placebop=NSTIMIIIIAInvestigators.Circulation1993;87:38-52.TIMIIIIAEffectsoftPAonCoronaryLesionsPrimaryResultsBASELINEANGIORAPHY:ANGIORAPHYAFTERtPA:2ASA,IVHeparin,Beta-blockers,Nitrates,Ca++blockersRandomizeETT6weeksEarlyInvasive:Cath18-48hPTCA/CABGprn1473PatientswithUnstableAngina/NQWMIEarlyConservative:STHolter,ETTThalliumCath/PTCAif+ischemia1oEndpointInv-Cons:Death,MI,PositiveETT-6weeksFollow-up1yearCirculation1994;89:1545-562x2Factorial:t-PAvs.Placebo1oEndpointt-PA:Death,MI,RecIsch,+ETT,ThalliumorSTHolter

TIMIIIIBProtocolDesign3TIMIIIIBInvestigators.Circulation1994;89:1545-56

TIMIIIIBtPAvs.PlaceboinNon-STElevationACSPrimaryResultsCompositeEndpointDeathorMIICH%ofPatientsP=NSP=0.05P=0.054Eventsat42d InvasiveConservative pvalueNo.Pts 740733 Death(%) 2.4 2.5 NSMI(%) 5.1 5.7 NSD/MI/+ETT(%) 16.2 18.1 NSRehospAngina(%)7.8 14.1 <0.001D/MI/Rehosp(%) 15 22 0.007LOS(days) 10.2 10.9 <0.001#Daysrehosp 365 930 <0.001TIMIIIIBInvestigators.Circulation1994;89:1545-56

TIMIIIIBEarlyInvasivevs.ConservativeStrategyPrimaryResults5Allconsecutivepatientsadmittedwithunstableanginawerescreened.InclusionCriteria:Ischemicpain>5minswithin96hrswithunstablepattern:Atrest,accelerating,postMIExclusionCriteria:Non-ischemicpain,STelevation,admittedforrevascularizationprocedurePatientsinspecificsubgroupsdefinedbygender,raceandagewererandomlyselectedfordetailedevaluationandfollow-upat6weeksand1year.

TIMIIII

REGISTRYProtocolDesign62.63.6110.86.622.91.63.76.81.63.78.2In-Hospital6Weeks1Year0510152025%ofPatientsSTdeviation>0.1mVLBBBTwchangeNoECGchanges_StonePH,TIMIIIIRegistryStudyGroup.JAMA1996;275:1104-1112.CannonCPetalforECGSubstudyInvestigators.JACC1997;30:133-40.

TIMIIII

REGISTRYAdmissionECGasaprognosticindicatorRiskStratificationDeathorMI7Antmanetal.NEJM1996;335:1342-9Enrolled0-6hrs